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At least 1,135 records · Page 63Linked to original sources
PubMed1985

Use of the artificial sphincter in the treatment of urinary incontinence.

Data analysis of my experience with the implantation of the artificial sphincter shows an overall success rate of 84%. These results are in 139 females ranging from 5 to 84 years of age. The surgery is difficult primarily because the urethral-vaginal septum is not a surgical plane. Even partial injury to these tissues can lead to failure with erosion of the device into the urethra or vagina. The use of a new surgical instrument, the 'cutter clamp' (Figure 8A-F), is expected to improve results because of the precision it offers in dissecting around the bladder neck. Infection occurred in four out of 139, or 3% of the cases. In one infected case, the cuff eroded into the urethra. The infection rate may actually be higher since infection might account for some of the other erosions which occurred. Once erosion occurs, secondary infection can obscure the fact that the device was contaminated at the time of the original implantation. The use of a surgical isolation bubble system may lower both the incidence of infection and erosions in the future. The relief to the totally incontinent female by the artificial sphincter cannot be overestimated. The patients are very grateful, especially since most have undergone multiple treatment methods in an effort to cure their incontinence. The effectiveness of the device, barring infection or erosion, is evident by a success of 91% of such patients being socially continent and 66% being completely dry.

Adolescent↗
PubMed1997

Combined transconjunctival/intranasal endoscopic approach to the optic canal in traumatic optic neuropathy.

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.

Adolescent↗
PubMed1999

Feasibility of minimally invasive intrauterine fetal access in a monkey model.

PURPOSE: We evaluated new intervention techniques and surgical instruments in a fetal monkey model to determine improvements that would be useful for early intrauterine intervention. Our findings may be helpful in the future for treating select cases of severe prenatal obstructive uropathology. MATERIALS AND METHODS: In a series of experiments on 18 pregnant rhesus monkeys (Macaca mulatta) at mid trimester we assessed various endoscopic intra-amniotic access techniques as well as morbidity, mortality and possibilities for fetoscopy. RESULTS: In all 18 fetuses adequate fetoscopy was possible with no maternal mortality. Of the 18 pregnancies 14 went to term with no early or late postoperative complications. Technical improvements changed the intrauterine access technique from open placement of trocars to the use of the Seldinger technique, gun introduction of needles with small caliber sheets and small caliber introduction trocars, resulting in minimal amniotic membrane separation. Various rigid and flexible endoscopes were evaluated for fetoscopy and up to 3 cannulas were placed. No change in the fetal growth pattern was observed on postoperative ultrasound. Subsequent pregnancies occurred during this study period, and there were no acceptance problems of the newborns by the mothers. CONCLUSIONS: New techniques have led to improved intrauterine fetal access. Morbidity mainly depends on the disruption of amniotic membranes, which has an important preterm role. Adapted endoscopes and other instruments offer new possibilities for fetal diagnosis and therapy in the future. Our primate model seems to be suitable for evaluating these new techniques before they are used in a clinical setting.

Animals↗
PubMed2003

The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery.

The United States Department of Defense developed the telepresence surgery concept to meet battlefield demands. The da Vinci telerobotic surgery system evolved from these efforts. In this article, the authors describe the components of the da Vinci system and explain how the surgeon sits at a computer console, views a three-dimensional virtual operative field, and performs the operation by controlling robotic arms that hold the stereoscopic video telescope and surgical instruments that simulate hand motions with seven degrees of freedom. The three-dimensional imaging and handlike motions of the system facilitate advanced minimally invasive thoracic, cardiac, and abdominal procedures. da Vinci has recently released a second generation of telerobots with four arms and will continue to meet the evolving challenges of surgery.

Equipment Design↗
PubMed2001

Minimal access surgery in managing anterior lumbar disorders.

Traditional anterior lumbar surgery usually requires a long and sometimes painful skin incision. The current study evaluated the feasibility and safety of minimal access surgery for anterior lumbar disorders, emphasizing indications, operative technique, and the minimum 2-year followup results. From May 1996 to December 1997, the authors used this technique on 25 patients whose indications for surgery included syndromes of failed back surgery, selected cases of lumbar disc herniations, tuberculous or pyogenic spondylitis, selected spondylolisthesis, and vertebral tumors. In 23 of 25 patients, the site of interest was approached through a left flank incision, regardless of the laterality of the lesion. The mean length of the main incision was 5 cm. There were no injuries to great vessels or any neurologic deterioration after the procedures. Solid interbody fusion could be identified radiographically between 3 and 6 months after surgery. At a mean followup of 39.6 months, nine patients had excellent clinical outcomes, 11 patients had good outcomes, two patients had fair outcomes, and one patient had a poor outcome. The authors think such minimal access surgery is simple, effective, and safe for anterior lumbar disorders. The merits of the current technique include no need for endoscopic, microscopic, or complex surgical instruments, a lower amount of radiation exposure during surgery, and a shortened learning curve because the approach is similar to the anterior open lumbar technique, although the skin incision is only 5 cm in length.

Adult↗
PubMed2006

Design of a minimally invasive non fusion device for the surgical management of scoliosis in the skeletally immature.

Current management of scoliosis in the skeletally immature focuses on prevention of curve progression. Progressive curves require surgical instrumentation without fusion with periodic lengthening of the construct, continuous bracing and ultimately fusion of the curve when control is lost at the adolescent growth spurt. This treatment regime has a major negative impact on the childs biopsychosocial profile and yields relatively poor longterm results. The aim of this study was to define the ideal characteristics of a growing rod and design a novel implant based on these characteristics. The method used was logical thought to define the desired implant characteristics and then design an implant which approximated the theoretical model as closely as possible. An ideal growing rod would grow with the spine, correct the deformity as growth occurred, leave no residual deformity at maturity, not require activity restriction/bracing, not require fusion at maturity and be compatible with a minimally invasive surgical technique. The ideal growing rod (IGR) is modular consisting of a number of units linked together which conform to the shape of the deformed spine. Each unit spans a disc space and consists of a telescopic rod with one end attached to the vertebra above and the other to the vertebra below. The rod is pushed apart by the force of growth but can only elongate in a predetermined direction resulting in a three dimensional realignment of the instrumented spinal segments with growth. In conclusion it is possible to design a growing rod with theoretical advantages over current constructs.

Child↗
PubMed1995

New technique for lesser saphenous vein harvesting.

A new technique using the Thompson self-retaining retractor system (Thompson Surgical Instruments, Inc, Traverse City, MI) to harvest lesser saphenous veins is presented. This modification, used in 10 patients undergoing redo myocardial revascularization, provided a rapid, comfortable, and convenient method for harvesting lesser saphenous veins.

Coronary Artery Bypass↗
PubMed2001

[Evaluation of cost of laparoscopic surgery in gynecology].

The objective of this work was to evaluate hospital and postoperative costs associated with gynecologic laparoscopic surgery for benign pathologies. Hospital costs were broken down into several categories: operating room, postoperative hospitalization, pharmacy, surgical instruments, sterilization of reused equipment, food and laundry, indirect costs. The mean total costs for the hospitalization time were 8547,2 francs. Medical charges in recovery time were calculated with the help of the Social Security. These charges represented less than 5% of the total cost associated with the procedure.

Drug Costs↗
PubMed2001

Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations.

OBJECTIVE: The evolution of the senior author's (HD Jho) surgical experience on endoscopic endonasal transsphenoidal pituitary surgery is reviewed in order to introduce a standardized surgical technique for pituitary endoscopy. METHODS: The progressive evolution of the surgical technique and the development of surgical instrumentation in transsphenoidal endoscopy is reviewed based upon the experience of more than 150 operations performed by the senior author between the years 1993 and 1998. RESULTS: An endoscope was used to assist visualization during conventional microscopic surgery in the first four cases (endoscope-assisted microsurgery). Subsequently, endonasal pituitary endoscopy was performed via a nostril. When the endonasal route was adopted, it eliminated the use of a transsphenoidal retractor. The use of vasoconstrictors and any form of nasal packing was discovered to be unnecessary. The inferior margin of the middle turbinate was such a consistent surgical landmark leading to the sella that the use of an intraoperative fluoroscopic C-arm was also eliminated. The adoption of a septal breaker, variously angled suction cannulas and suction-coagulators has made the operation cleaner, easier and faster. As experience increased, the operation time progressively shortened and mucosal trauma became minimal. The median patient hospital stay was one night and postoperative discomfort was noted to be minimal. CONCLUSIONS: The evolution of the senior author's endoscopic pituitary surgery is reported with a description of our current standardized surgical technique.

Acromegaly↗
PubMed1998

Upper T mini-sternotomy for aortic valve operations.

OBJECTIVES: New minimally invasive approaches for cardiac surgical procedures are constantly being developed in the hope of decreasing patient morbidity and enhancing the postoperative recovery. This report reviews the use of an upper T mini-sternotomy approach to aortic valve surgery. PATIENTS: Nine consecutive nonselected patients (5 men, 4 women, mean age, 66 years) underwent isolated aortic valve replacement with the use of this approach. Two patients had isolated aortic valve stenosis, three had isolated aortic valve incompetence, and four patients had mixed aortic valve disease. RESULTS: In all cases, an excellent view of the aortic valve was obtained, aortic valve replacement with a bileaflet mechanical prostheses was performed, and no intraoperative difficulties were encountered. Mean aortic cross-clamp time was 83 min and mean cardiopulmonary bypass perfusion time was 97 min. All patients were extubated in the operating room at the end of the surgical procedure, and there were no postoperative complications. All patients were discharged home on postoperative day 3, and there were no late complications. CONCLUSION: Through an upper T mini-sternotomy, aortic valve surgery can be performed in the conventional manner using standard surgical instruments with no alteration in cardiopulmonary bypass and myocardial protection routines. With this method, postoperative pain is reduced and patient recovery is expeditious.

Aged↗
PubMedDate not supplied

Radioguided surgery of breast cancer: radiation protection survey.

The aim of this study was to estimate the radioactive risk for surgical staff performing radioguided sentinel lymph node (SN) biopsy and to calculate the contamination level in the operating room for assessment of the possible need for specific radiation protection procedures. We studied 20 patients who were selected for quadrantectomy and SN biopsy. The day before surgery a volume of 0.15 mL of 99mTc-nanocoll was injected: the activity was 3.11 +/- 0.85 MBq in group A (15 pts) and 11.6 +/- 0.6 MBq in group B (5 pts). External radiation to staff was evaluated by measuring the exposure rate in air one hour after radiopharmaceutical administration. The air KERMA rate during surgery was estimated considering the physical decay of 99mTc. Contamination of disposable materials and surgical instruments in the operating room was measured using a contamination monitor, whereas the residual activity in the SN and the injection site was measured with a gamma probe. The exposure rate at 20 cm from the injection site was 0.75 microSv/h when the most radioactive patients (group B) were treated. Contamination in the operating room proved to be negligible. Considering the number of radioguided treatments carried out by a surgeon in one year, an equivalent effective dose of 0.075 mSv was estimated; the recommended dose limit according to the relevant Italian law, DL 230/95, is 1 mSv/yr. Surgical staff therefore do not require a classification of "exposed workers" and there is no need to supply the operating room with special containers for radioactive waste.

Breast Neoplasms↗
PubMed1990

Interactive sonar-operated device for stereotactic and open surgery.

An accuracy of +/- 1 mm in surgical localization of brain targets was reliably attained with a new sonar-operated system, provided that air turbulence was minimized. Since a conventional frame construction with coordinate settings has been disposed of, apart from a halo ring head holder, free access to the operating site is guaranteed. Using offset probes, measurements in depth can be realized with a relatively simple hardware arrangement. A small, 'floating' locator probe can be attached to all kinds of surgical instruments; its spatial position is computed in real time and immediately referred to computed tomography/magnetic resonance imaging scans. Although this work is still in progress, promising applications both in stereotactic and in open surgery are envisaged.

Angiography, Digital Subtraction↗
PubMed1998

Motion feedback as a navigation aid in robot assisted neurosurgery.

This paper describes a test prototype for precision robot-assisted surgery using a hexapod operating robot and a movable operating cockpit. The objective of the work described is twofold: 1) To evaluate the use of hexapod robots for precisely manipulating endoscopes and surgical instruments in sub-millimeter surgery. 2) To test a new user interface concept based on motion feedback. This paper gives an overview of the system components and the user interface concept, and reports results from initial tests. Finally, the paper investigates potential applications and areas for further development.

Evaluation Studies as Topic↗
PubMed2005

[Modified detachable deschamps ligature carrier (MDDLC) in sacrospinous ligament fixation (SSLF)].

OBJECTIVES: The study presents modified detachable Deschamps ligature carrier (MDDLC), which applied in sacrospinous ligament fixation (SSLF) procedure allows for suture placement through the sacrospinous ligament in a limited pararectal space. MATERIALS AND METHODS: Prototype of new surgical instrument has been applied in paravaginal procedures suspending vaginal vault to the sacrospinous ligament among other reconstructive procedures performed on nine patients with genital prolapse. RESULTS: No complications have been noticed with the use of new device. CONCLUSIONS: MDDLC, designed and accomplished by authors, is simple in its construction and easy in application.

Equipment Design↗
PubMed2005

Are sterile water and brushes necessary for hand washing before surgery in Japan?

PURPOSE: To examine whether sterile water and brushes are necessary for hand washing before surgery. METHOD: Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. RESULTS: No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. CONCLUSIONS: Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

Anti-Infective Agents, Local↗
PubMedDate not supplied

[External saphenous vein excision with mini-phlebectomy].

The surgical treatment of the varicosities of the short saphenous vein is one of most controversial matter of modern phlebology. The anatomy of this vessel, that is deep, and is accompanied by the sapheno external nerve, can be very varied species for that which concerns the sapheno popliteal joint. The traditional surgery as the sclerotherapy exposes the patient to risks and failures. For such reasons the authors believe that the modern technique of stab evulsion phlebectomy could be formatted like the treatment of choice of the venous pathology of the short saphenous vein. Synthesizing, the stab evulsion phlebectomy consists of the removal of the varicosities of the lower limbs through incisions of the skin of 1-3 mm using special surgical instruments with hook (Chrochets). The technique doesn't foresee neither stitching neither vascular binding, and could be performed on local anesthesia and in ambulatory regimen. The results of the technique and the absence of complications suggests its adoption of principle in the treatment of the incompetence of the short saphenous vein.

Humans↗
PubMed1999

Cryosurgery for recurrent prostate cancer following radiation therapy.

Patients with prostate cancer are commonly treated medically or undergo radical prostatectomy and/or radiation therapy. Radiation therapy is usually selected for patients with local or regional disease and patients for whom traditional surgery has failed. The local recurrence of cancer in patients treated with radiation therapy presents a difficult challenge regarding the selection of further treatment options. A commonly applied treatment is salvage prostatectomy, but it can be difficult and complicated, with positive surgical margins occurring in as many as 50 percent of patients and with significant postoperative morbidity. Hormonal therapy, which is not curative, has served as an alternative to surgery in patients who have failed to respond to radiation therapy. Cryosurgery, the destruction of diseased tissue by freezing, is increasingly used both as a first-line therapy and as a second-line therapy (salvage therapy) in patients for whom radiation therapy has failed. Recent reports suggest that cryosurgery may be a useful alternative procedure for treating some of these patients with recurrent cancers. Outcomes of cryosurgery are improving through better instrumentation, surgical technique, and experience. The available data suggest that some patients with radioresistant cancer appear to benefit from the use of cryosurgery as a salvage therapy. Use of this technique has resulted in biochemical disease-free survival for varying periods of some patients who had recurrent prostate carcinoma following radiation therapy; however, morbidity remains high and relatively few patients have had adequate followup. Salvage cryosurgery prospective clinical trials are warranted and would help determine long-term survival benefits and make possible the comparison of cryotherapy patient survival rates with those of untreated biopsy-positive patients.

Cryosurgery↗
PubMed1999

Model-updated image guidance: initial clinical experiences with gravity-induced brain deformation.

Image-guided neurosurgery relies on accurate registration of the patient, the preoperative image series, and the surgical instruments in the same coordinate space. Recent clinical reports have documented the magnitude of gravity-induced brain deformation in the operating room and suggest these levels of tissue motion may compromise the integrity of such systems. We are investigating a model-based strategy which exploits the wealth of readily-available preoperative information in conjunction with intraoperatively acquired data to construct and drive a three dimensional (3-D) computational model which estimates volumetric displacements in order to update the neuronavigational image set. Using model calculations, the preoperative image database can be deformed to generate a more accurate representation of the surgical focus during an operation. In this paper, we present a preliminary study of four patients that experienced substantial brain deformation from gravity and correlate cortical shift measurements with model predictions. Additionally, we illustrate our image deforming algorithm and demonstrate that preoperative image resolution is maintained. Results over the four cases show that the brain shifted, on average, 5.7 mm in the direction of gravity and that model predictions could reduce this misregistration error to an average of 1.2 mm.

Adolescent↗